JCAHO Guidelines for Making Assignments

The Joint Commission on Accreditation of Health Care Organizations speaks specifically to the assignment of responsibilities in the following manner:

When assigning each staff member's responsibility for providing nursing care to the patients, the registered nurse considers factors related to 1) the patient, 2) the environment in which nursing care is provided, 3) the nursing staff member's  competence, and 4) the degree of supervision required by and available to each nursing staff member assigned responsibility.

Assigning responsibility to nursing staff members for providing nursing care to patients is based on consideration of the following seven elements:

• the complexity of the patient's condition and the required nursing care;
• the dynamics of the patient's status, including the frequency with which the need for specific nursing care changes.
• the complexity of the assessment required by the patient, including the knowledge and skills required of a nursing staff member in order effectively complete the required assessment;
• the type of technology employed in providing nursing care, with consideration given to the knowledge and skill required to effectively use the technology;
• the degree of supervision required by each nursing staff member based on his/her previously assessed level of competence in relation to the nursing care needs of the patient(s). 
• The availability of supervision appropriate to the assessed and current competence of the nursing staff members(s);
• relevant infection control and safety issues (for example, cardiopulmonary procedures (CPR).

From the Accreditation Manual for Hospitals, Joint Commission for Accreditation for Health Care Organizations, July/August 1990, NC.2-NC2.1.22.2

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